| NPI | 1275675456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 3710) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 002154) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |